Mention the words ‘root canal’ to many people and watch them cringe.  The worst things in life are often compared to the ‘dreaded root canal.’  I had a patient tell me, “Doc, I would rather have an IRS audit than a root canal.”  That makes me cringe because a root canal should not be a big deal.  Now an IRS audit, that is scary!

Tooth pain can be the excruciating.  Luckily, root canal therapy can relieve intense tooth pain and save one’s tooth.  There is no better joy than that relief.  

There are three main reasons for root canal therapy.

Tooth fracture  

When a tooth is broken from an accident and the pulp is exposed,  root canal therapy is needed.  Five years ago, a high school boy had his front teeth broken in a fight.  One front tooth was knocked out of place and had to be reset and stabilized.  His other front tooth was fractured into the nerve’s pulp chamber.  Both front teeth needed root canal therapy.  Whitening and bonding were done to give him his original smile.  Recently, now that  he is older, more mature, and less physically active, he had two esthetic crowns placed.  

Seven years ago, I treated a 51-year-old male patient who had a bizarre accident.  While looking up pruning, the metal head of the spring-loaded pruner broke and hit him in the mouth, shattering one upper central tooth and fracturing the other.  The shattered tooth had to be removed and an implant placed, while the fractured tooth needed root canal therapy.  After cosmetic porcelain crowns, he had a beautiful smile again. 

From 1968 to 1972, I worked summers for PG&E as a laborer in order to save money for college.   I became an excellent ditch digger and pretty good with a jackhammer as well.  I am still pretty good with a shovel, but I need to rest after a couple of hours.  Construction work was good background for dentistry, drilling and filling on a bigger scale.  When I was 20, I had a jackhammer bounce back and hit me in the mouth, fracturing my two upper front teeth, one of which caused the nerve to be exposed.  With root canal therapy and two crowns placed, treatment was successful, and I still have my teeth today.

Deep decay

The classical reason for root canal therapy is decay into the nerve, which can cause severe pain.  If left untreated, the infection can spread through the root of the tooth into the jawbone causing an abscess.  The infection often travels into the soft tissues of the cheek, causing severe swelling.  Tooth infection has been known to transmit into the eye, neck and brain and even caused death.  

Often, people wait way too long to seek treatment from a tooth infection, until they are in excruciating pain and their face is severely swollen. Treatment becomes much more difficult.  The swelling dilutes the injection, so numbing the infected tooth becomes much harder. This is the reason that root canal therapy has the reputation of being so awful and butt of many jokes. 

 Last month, a 54-year-old man had deep decay and severe pain in his lower right molar.  Digital x-ray showed the infection had spread into the nerve of the tooth and was causing an abscess at the tip of his root.  He had been putting off treatment for years because of dental fear and fear of the dreaded root canal. The pandemic didn’t help. Placed on antibiotics, the pain and infection were reduced.  With conscious sedation, root canal therapy was completed along with numerous tooth-colored fillings.  The next day, I called him; he was extremely happy, thankful and pain free for the first time in many years.

Tooth trauma

Over half the root canal therapies done are in teeth that have had years of trauma.  Trauma comes in many forms, including years of heavy chewing, grinding, or clenching, causing a constant pounding on the teeth. Hot and cold foods and drink also traumatize teeth over time. I used to have a bad habit of  drinking ice water and hot coffee together, which put severe stress on  my teeth. Constant temperature of food and drink is best. Also tooth decay and treatment for decay with fillings or crowns have a stressful effect.                                                                                                                                  

The pulp recedes in a traumatized tooth, trying to protect itself by laying down a new layer of tooth insulation, called secondary dentin. In the process it also lays down tooth structure in the canal, narrowing the canal, which cuts off its own circulation. In essence it strangles its own nerve, which dies and loses normal sensation. This begins an inflammatory response.  The body is constantly cleansing itself and sending white blood cells to remove the dead tissues.  However, the white bloods cells cannot get into the narrow canal in a tooth to clean out the dead tissue, so an inflammatory abscess forms in the bone at the tip of the root. This causes different levels of pain, from slight to severe that can come and go. Usually, there is a low grade, dull achy feeling in the jawbone.

Trauma from years of old silver-mercury fillings also causes teeth to die and necessitate root canal therapy.  Most of the  root canal therapies done are on teeth with large silver-mercury fillings.  These fillings cause long-term sensitivity to the nerve by transmitting hot and cold.  Silver is the best conductor of temperature and electricity.  These fillings also act like wedges in the teeth, expanding and contraction causing cracks and fractures.  The pulp recedes from this abuse, become asphyxiated, begins an inflammatory response, and leads to a toothache.  Root canal therapy can save the day.  

Grinding and clenching are the most common cause of tooth trauma.  Teeth should only touch when we chew food, approximately 30 minutes a day.  Someone who grinds can do years of trauma to his or her teeth in a short time.  When not in the act of chewing, there should always be space between the teeth.  Studies have shown that over half the population does some grinding or clenching during sleep.  This continual pounding between the teeth causes them to die and begin an inflammatory response.

A lady patient in her mid-30s has had to have six root canal therapies done over the last 5 years from heavy grinding during sleep.  These teeth had no decay or fillings.  She just pounded them to death causing her major pain.  All the root canal therapies were effective, and I finally convinced her to wear a night guard to protect her teeth.  She is now doing great, pain free.     

Natural teeth are meant to last a lifetime.  So, if one of your teeth becomes critically injured or diseased, it is best to save it with root canal therapy.  Root canal therapy should be cherished as a joyous advancement in dentistry to save teeth and eliminate pain rather getting a bad rap as the ‘dreaded root canal.’ 


George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at

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